Psychiatric symptoms in patients with lung cancer following postoperative acute respiratory distress syndrome

Table 1 Comparison of general data between the positive and negative composite outcome groups, n (%)/mean ± SD

Indicators	Positive outcome group (n = 113)	Negative outcome group (n = 87)	χ2/t	P value
Sex
Male	69 (61.06)	66 (75.86)	4.257	0.039
Female	44 (38.94)	21 (24.14)
Age (years)	65.02 ± 7.84	62.67 ± 7.77	2.112	0.036
Body mass index (kg/m2)	23.74 ± 2.82	23.26 ± 3.21	1.085	0.279
Smoking history	53 (46.90)	47 (54.02)	0.732	0.392
Complications
Chronic obstructive pulmonary disease	29 (25.66)	23 (26.44)	0.000	1.000
Hypertension	31 (27.43)	33 (37.93)	2.030	0.154
Diabetes	22 (19.47)	12 (13.79)	0.756	0.385
Pathological type
Glandular cancer	75 (66.37)	61 (70.11)	1.216	0.544
Squamous carcinoma	25 (22.12)	20 (22.99)
Others	13 (11.50)	6 (6.90)
Tumor-nodes-metastasis staging
Stage I	40 (35.40)	36 (41.38)	1.422	0.491
Stage II	36 (31.86)	29 (33.33)
Stage III	37 (32.74)	22 (25.29)

Table 2 Comparison of perioperative and acute respiratory distress syndrome-related variables between groups in the retrospective cohort, n (%)/mean ± SD

Indicators	Positive outcome group (n = 113)	Negative outcome group (n = 87)	χ2/t	P value
Surgical method
Thoracoscope	78 (69.03)	72 (82.76)	4.238	0.040
Thoracotomy	35 (30.97)	15 (17.24)
Resection range
Segmentectomy/wedge resection	17 (15.04)	13 (14.94)	0.246	0.884
Lobectomy	79 (69.91)	63 (72.41)
Total pneumonectomy	17 (15.04)	11 (12.64)
Acute respiratory distress syndrome classification
Mild	37 (32.74)	48 (55.17)	12.101	0.002
Moderate	46 (40.71)	29 (33.33)
Severe	30 (26.55)	10 (11.49)
Mechanical ventilation time (days)	5.05 ± 1.88	4.13 ± 1.76	3.573	< 0.001
Intensive care unit stay time (days)	7.37 ± 2.37	6.38 ± 2.10	3.114	0.002
Numerical Rating Scale score for postoperative pain (points)	4.98 ± 1.14	4.59 ± 1.11	2.446	0.015
Albumin on postoperative day 3 (g/L)	36.21 ± 3.30	36.91 ± 3.34	-1.473	0.142
Postoperative delirium	36 (31.86)	13 (14.94)	6.717	0.010
Postoperative pulmonary complications	27 (23.89)	24 (27.59)	0.185	0.667

Table 3 Distribution of anxiety, depression, and sleep disturbance in patients with different severity of acute respiratory distress syndrome, n (%)/mean ± SD

Indicators	Mild (n = 85)	Moderate (n = 75)	Severe (n = 40)	χ2/F	P value
Anxiety	15 (17.65)	17 (22.67)	11 (27.50)	1.368	0.505
Depression	9 (10.59)	15 (20.00)	12 (30.00)	7.045	0.030
Sleep disturbances	21 (24.71)	26 (34.67)	24 (60.00)	15.138	0.001
Composite outcome	37 (43.53)	46 (61.33)	30 (75.00)	10.432	0.005
HADS-A (points)	6.02 ± 2.25	7.58 ± 2.10	8.59 ± 2.36	18.521	< 0.001
HADS-D (points)	4.98 ± 2.71	6.51 ± 2.29	7.50 ± 3.02	13.245	< 0.001
PSQI (points)	5.67 ± 2.42	8.69 ± 2.63	10.81 ± 3.08	53.874	< 0.001

χ² test was used for classified variables (χ²) and analysis of variance (F) was used for continuous variables. HADS-A: Hospital Anxiety and Depression Scale-Anxiety; HADS-D: Hospital Anxiety and Depression Scale-Depression; PSQI: Pittsburgh Sleep Quality Index.

Table 4 Overlapping patterns of anxiety, depression, and sleep disturbance

Model	Number of cases	Constituent ratio (%)
Anxiety only	22	11.00
Depression only	15	7.50
Sleep disturbances only	43	21.50
Anxiety + depression	5	2.50
Anxiety + sleep disturbance	12	6.00
Depression + sleep disturbance	12	6.00
Anxiety + depression + sleep disturbance	4	2.00
None	87	43.50

Table 5 Univariate logistic analysis of factors associated with the composite psychological sleep outcome

Variables	β	SE	Wald χ2	OR	95%CI	P value
Female	0.695	0.317	4.818	2.004	1.078-3.725	0.028
Age ≥ 65 years old	0.237	0.288	0.677	1.267	0.722-2.222	0.409
Thoracotomy	0.966	0.349	7.672	2.154	1.086-4.270	0.028
Moderate acute respiratory distress syndrome	0.317	0.297	1.140	1.373	0.767-2.459	0.286
Severe acute respiratory distress syndrome	1.023	0.396	6.675	2.783	1.276-6.071	0.010
Mechanical ventilation time ≥ 5 days	0.693	0.301	5.297	2.000	1.109-3.606	0.021
Intensive care unit stay time ≥ 7 days	0.439	0.291	2.279	1.552	0.879-2.741	0.130
Postoperative pain NRS ≥ 5 points	0.731	0.296	6.101	2.076	1.167-3.693	0.013
Postoperative delirium	0.978	0.364	7.218	2.661	1.309-5.413	0.007

OR: Odds ratio; CI: Confidence interval.

Table 6 Multivariable logistic regression analysis of factors associated with the composite psychological sleep outcome

Variables	β	SE	Wald χ2	OR	95%CI	P value
Female	0.926	0.346	7.168	2.525	1.284-4.964	0.007
Severe acute respiratory distress syndrome	1.247	0.481	6.719	3.481	1.356-8.938	0.010
Thoracotomy	0.829	0.375	4.891	2.289	1.098-4.773	0.027
Postoperative delirium	0.846	0.407	4.324	2.330	1.048-5.181	0.038

A positive composite psychological-sleep outcome was considered as the event; the absence of anxiety, depression, and sleep disturbance was used as the reference. OR: Odds ratio; CI: Confidence interval.

Table 7 Exploratory multivariable logistic regression models for anxiety, depression, and sleep disturbance

Outcome	Variables	β	SE	OR (95%CI)	P value
Anxiety	Female sex	0.742	0.365	2.100 (1.027-4.294)	0.042
Anxiety	Severe acute respiratory distress syndrome	0.982	0.452	2.669 (1.102-6.461)	0.030
Anxiety	Postoperative delirium	0.908	0.421	2.480 (1.087-5.658)	0.031
Depression	Severe acute respiratory distress syndrome	1.188	0.471	3.281 (1.304-8.259)	0.012
Depression	Postoperative delirium	0.859	0.438	2.361 (1.000-5.574)	0.050
Sleep disturbance	Severe acute respiratory distress syndrome	1.416	0.427	4.121 (1.783-9.523)	0.001
Sleep disturbance	Thoracotomy	0.904	0.367	2.470 (1.204-5.068)	0.014
Sleep disturbance	Postoperative pain NRS ≥ 5 points	0.802	0.346	2.230 (1.132-4.394)	0.020
Sleep disturbance	Mechanical ventilation time ≥ 5 days	0.658	0.329	1.931 (1.014-3.678)	0.045
Sleep disturbance	Postoperative delirium	0.772	0.389	2.164 (1.010-4.635)	0.047

Each outcome-specific model was adjusted for clinically relevant variables selected from the a priori domains. These exploratory models were based on retrospective clinical data and should be interpreted as exploratory findings. OR: Odds ratio; CI: Confidence interval; NRS: Numerical Rating Scale.